SIM small grants fuel practice transformation part 4

By Meg Quiat, JD, SIM grants administrator

This regular column features SIM small grant recipients and the ways in which they are using grant funds to help them in their practice transformation journeys.  Learn more about how the SIM small grants are helping practices by clicking the links below and stay tuned for more updates.


SIM practices use small grant funds to train care teams in behavioral health integration

During SIM Cohort 1, 47 SIM practices were awarded small grants through the Center for Medicare & Medicaid Innovation (CMMI) and the Colorado Health Foundation funding streams to support a variety of practice integration plan goals. Of those 47 practices, 11 have used funds to train staff in behavioral health integration, as outlined below. The process is unique to each practice, and since grant recipients range from small to large practices that are independent and part of larger healthcare systems, you will see diversity in the approaches listed below.

Practices that dot the map in rural and urban areas, metro Denver and mountain towns used small grant funds to train team members in these aspects of integrated healthcare:

  1. Suicide awareness training: How to identify patients at risk for suicide.
  2. Understanding the importance of behavioral health screenings, tracking and referrals.
  3. Motivational interviewing: Partnering with patients to increase “change talk” that helps with addiction issues and encourages behavior changes.
  4. Crisis de-escalation trainings: Improve staff members’ ability to safely address issues arising from interactions with abusive or violent patients or to resolve conflict.
  5. Trauma-informed care: Teaching staff how to provide services that ensure patient safety, build trust, encourage choice and collaboration, encourage patient empowerment, and which demonstrate cultural competence.
  6. Communication and patient engagement: Customized trainings to target practice challenge areas and build specific communications skills, including culturally and socially-based communication.
  7. Certification of medical assistants as health coaches through online training.
  8. Integrating behavioral and physical health training to improve behavioral health counselors’ skills in primary care facilities. 

Many practices hired trainers to provide onsite trainings so providers and staff could rotate training attendance times and keep the clinic staffed. Other practices sent staff and/or providers to pre-scheduled trainings off-site. Several practices purchased online trainings to coordinate with schedules.

Some practices received in-person, customized training from well-respected trainers for all or specific staff members and providers. Other practices used the “train the trainer” method with behavioral health providers, who trained other staff and providers. No one method of training worked better than others for all practices. Each practice designed the training type, schedule and venue to meet its individual needs.

Some of the challenges sited by practices that used small grant funds to train staff and providers include:

  1. Scheduling challenges to allow a practice to remain open during trainings.
  2. Financial considerations related to lost clinic billing time.
  3. When purchasing self-training materials for staff and providers it was challenging to keep staff interested and engaged in completing the training independently. Some staff said that finding time outside work was difficult and slowed the education process.
  4. High turnover rate makes it difficult for trainings to benefit the practice long term.


Practices that used small grant funds for staff and provider trainings said benefits significantly outweighed challenges. Highlighted benefits and reported “takeaways” include:

  1. One practice reported that suicide awareness training contributed to increased rates of PHQ assessment from an annual rate of 29% for 2016 for all eligible patients to 58% in quarter 1 2017 and 60.4% in quarter 2 2017. The same practice group reported that training across all levels of the system has engaged staff to work together to support patients and ensure safety. By offering training to all staff, “behavioral health concerns became more mainstream for all staff and we are hopeful that stigma was reduced,” said one practice representative.
  2. Another practice says: An important part of taking care of our patients with a risk of suicide is to collaborate with community partners to provide a seamless link to the most appropriate support.
  3. Another clinic saw a 5% increase in Press Ganey Patient Experience scores after its trainings collected through emailed patient experience surveys after each patient visit. The increase occurred between March (when training was offered) and June 2017.
  4. One practice learned the importance of investing in staff development “so all staff understand the purpose and intent of integrated care. Front desk and medical assistants value their working relationships more, making the office a better place to work.” Another said the team learned the value of customizing a message to resonate with different communication styles, which improved team unity and function. A different practice representative said, training all clinical staff “improved our team concept by increasing the level of confidence the providers have towards their staff.”
  5. Increasing skills: One practice trained three medical assistants as certified health coaches and provided its diabetes nurse with specialized training to help her patients achieve better results. Medical assistants who obtained certification said the health coach training has greatly improved and changed the way they communicate with patients. “Most significantly was the increased confidence that our care management and behavioral health staff reported from the motivational interviewing portion of the course. We learned that health coaching techniques can be a positive clinical tool to tap into the ambivalence that a patient might struggle with in the self-management of chronic conditions.” The clinic diabetes nurse develops care plans and monitors the practice’s high-risk population. She is identifying those diabetics with care gaps and bringing them in for required testing when an office visit is not warranted. The practice has improved its diabetes poor control measure by 12% during the past two months with a trained diabetes nurse at the helm.